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House to begin work on health care law substitute

NEW:A Republican committee chairman says it is unclear if there will be one bill or many

The House passes a measure to start writing a new health care bill

Republicans are considering various ways to defund or replace the health care overhaul

Key Democrats have said they'll cooperate in the elimination of certain measures

Washington (CNN) -- House Republicans stepped up their campaign against President Obama's health care overhaul Thursday, voting to begin drafting a measure to replace the controversial new law.

Thursday's vote followed a first move Wednesday, when the GOP-controlled House voted largely on partisan lines to repeal the health care overhaul, fulfilling a Republican promise from last fall's midterm election.

However, the repeal vote was seen as largely symbolic. The legislation has virtually no chance of clearing the Democratic-controlled Senate or surviving a certain presidential veto. Senate Majority Leader Harry Reid, D-Nevada, has said he will prevent the chamber from voting on it.

Democrats say the health care overhaul passed last year was necessary to hold down spiraling costs and expand health coverage to millions of uninsured Americans while strengthening the rights of consumers in dealing with health insurers.

GOP leaders are nevertheless laying the groundwork for a sustained attempt at eroding support for Obama's signature domestic accomplishment. Republicans insist the reform will undermine long-term economic growth, and they see a strong political upside to continued debate on the measure.

Thursday's vote instructed four House committees to draft legislation "fostering economic growth and private sector job creation by eliminating job-killing policies" such as the health care law. House Speaker John Boehner, R-Ohio, has said there is no timeline on when a replacement bill will be unveiled. Political observers have said the process will last through the 2012 election.

In an opinion piece Thursday in The Wall Street Journal, Republican strategist Karl Rove wrote that this week's vote was "but the opening round" in the GOP's fight to repeal health care reform, and it "once again focuses public attention on the law's flaws."

The longer the issue is around, the worse it will be for Democrats, Rove wrote.

"The House vote also gives the GOP momentum to make ObamaCare a principal issue in the 2012 election," Rove wrote, referring to the health care reform measure passed last year with a label used by its opponents. "That can't make vulnerable House Democrats who barely survived last fall's campaign, or the 24 Democratic senators up in 2012 (many in red states), happy. Nor can it be to the advantage of the president, who will also be on the ballot."

House committees are scheduling hearings designed to expose what Republicans believe are shortcomings in the existing law. At a news conference Thursday, new Republican chairmen of four committees said all hearings and subsequent drafting of legislation would be conducted under regular rules, allowing both parties to present witnesses and propose amendments.

During the drafting and debate on the health care reform measure passed last year, Republicans complained that Democrats then leading the committees rammed through the Democratic proposal while sidestepping or ignoring GOP amendments and ideas. However, Democrats said Republicans spurred by the health insurance industry were only trying to obstruct progress on the issue.

New Ways and Means Committee Chairman Dave Camp, R-Michigan, said it was uncertain if the process launched Thursday would result in a single new health care overhaul measure or individual pieces of legislation tackling specific issues.

"We always felt that health care ought to be a step-by-step approach," Camp told reporters. "Those decisions haven't been made. Those decisions will be made as we move forward."

The House Judiciary Committee held a hearing Thursday exploring medical liability reform -- an issue that top Republicans have trumpeted for years.

Democrats rejected including medical liability reform in the health care measure, saying it was unclear if cracking down on frivolous medical malpractice lawsuits would have much impact. Republicans complained that the Democratic opposition on the issue was because of influence from the trial lawyer lobby.

Republican Rep. Lamar Smith of Texas, the new chairman of the House Judiciary Committee, insisted medical liability reform would save "tens of billions of dollars" for consumers and patients.

Next Wednesday, the tax-writing House Ways and Means Committee will hold a hearing questioning the impact of Obama's overhaul on the economy and, more specifically, employers' ability to hire new workers and retain employees.

Camp and the other new GOP committee chairmen said the goal is to come up with health care reform that lowers costs.

"We just want a whole different approach to health care," Camp said, calling the measure passed last year a "government-focused approach" and adding: "We want a patient-focused approach."

Democrats responded that Republicans are merely seeking to score political points without having any clear plan to offer.

"Throughout the more than year-long debate over health care reform, Republicans never offered an alternative plan of their own," Democratic Rep. Anthony Weiner of New York said in a statement. "Now, they pass a bill to repeal health care and instead of offering up their own proposal, they say 'let's have the committees try figure this all out.' "

Congressional Republicans have also said they will attempt to cut money for portions of the overhaul or eliminate specific provisions in the months ahead.

"We will do everything we can to delay and defund the provisions of the bill so that we can get some discussion going on how we can replace it, and come together on the agreement that we can't accept the status quo," House Majority Leader Eric Cantor, R-Virginia, told reporters Tuesday.

The GOP could, for example, try to cut funding for various Health and Human Services studies, as well as the hiring of Internal Revenue Service workers tasked with creating tax incentives in the law.

The IRS is also charged with enforcing the law's so-called individual mandate, a requirement for everyone to carry insurance. Top Republicans insist the provision is unconstitutional, and they could try to strip the IRS enforcement budget for that specific purpose.

Key Democrats have said they are prepared to cooperate in the elimination of certain measures considered excessively burdensome to businesses. Leading members of both parties have expressed concern about a rule, scheduled to take effect in 2012, requiring businesses to issue 1099 tax forms to any individual or corporation from which they purchase more than $600 in goods or services in a year.

A recent analysis from the nonpartisan Congressional Budget Office, however, indicates that Republicans may have trouble making significant progress with their strategy of cutting funding to the law.

The overhaul includes $106 billion in new spending authorizations that Congress will eventually need to appropriate, according to Budget Office Director Doug Elmendorf. But $86 billion of those authorizations cover politically sensitive programs that were in existence before the passage of health care reform.

Funding for certain key provisions -- such as the law's Medicaid expansion and the extension of new insurance subsidies -- cannot be cut without a direct repeal vote. Such a move would have little chance of passing the Democratic-controlled Senate.

In the short term, Republicans are continuing to slam Reid for his stated refusal to bring the House-passed repeal bill to a vote in the Senate.

The American people "deserve to see a vote in the Senate, and the Senate ought not be a place where legislation goes into a dead end," Cantor said Wednesday.

"The Democratic leadership in the Senate doesn't want to vote on this bill. But I assure you, we will," Senate Minority Leader Mitch McConnell, R-Kentucky, said in a statement.

Reid, in turn, slammed Republicans for engaging in "partisan grandstanding at a time when we should be working together to create jobs and strengthen the middle class."

Even if the House bill is taken up in the Senate, it has little chance of passage. The rules in the Democratic-controlled chamber would require a supermajority of 60 votes to break a filibuster. There are only 47 Republican senators.

Instead of repeal, defund?

Cantor has said that defunding the legislation may be his party's best effort to get the law changed.

"So if we are unsuccessful in seeing the Senate take up the repeal bill and the president signing a repeal bill of ObamaCare, we'll do everything we can to delay and defund the provisions of the bill so that we can get some discussion going on how we can replace it, and come together on the agreement that we can't accept the status quo," Cantor told reporters this week.

Other Republicans have said that while the repeal bill won't pass in the Senate, they hope using Congress' purse strings may do the trick.

When it comes time for the appropriations committee to fund programs, the GOP could try to cut funds to certain aspects of the bill, including: money to the Health and Human Services' studies and the hiring of Internal Revenue Service workers tasked with creating tax incentives in the law.

There is also some bipartisan support for getting rid of the requirement that businesses fill out a 1099 Internal Revenue Service form. Both sides say it creates a mountain of paperwork for businesses. Section 9006 of the health care bill -- just a few lines buried in the 2,409-page document -- mandates that beginning in 2012 all companies will have to issue 1099 tax forms not just to contract workers but to any individual or corporation from which they buy more than $600 in goods or services in a tax year.

Another option Republicans can take? Cutting funding to health care law-related programs in the upcoming omnibus spending bill. A temporary spending bill was passed in the lame-duck Congress; a new one needs to be passed soon.

There has been no indication from Republicans though that they would take that route.

Meanwhile, the nonpartisan Congressional Budget Office analysis indicates that Republicans may have trouble moving ahead with defunding the law.

The measure includes $106 billion in new spending authorizations that Congress will eventually need to appropriate, according to CBO Director Doug Elmendorf. But $86 billion of those authorizations cover politically sensitive programs that were in existence before the passage of health care reform.